Ossification in the rectus sheath following free rectus flap

Area of Science:

• Surgical complications
• Bone formation
• Tissue reconstruction

Background:

• Heterotopic ossification (HO) is an uncommon complication following surgical procedures, characterized by abnormal bone development in soft tissues.
• Free rectus flap reconstruction is utilized for lower limb defects, often involving abdominal incisions.
• Understanding the etiology of HO is crucial for preventing postoperative complications.

Observation:

• This report details an unusual case of HO occurring within the rectus sheath after harvesting a free rectus flap.
• The surgical approach involved a lower transverse incision, with the extremities used for concurrent iliac crest bone grafting.
• Notably, the wound associated with bone harvesting did not exhibit any complications.

Findings:

• Ossification was observed within the closed rectus sheath, a rare site for HO post-laparotomy.
• The specific surgical technique, including the transverse incision and proximity to bone harvest sites, is of particular interest.
• Absence of HO at the primary bone harvest site contrasts with the observed sheath ossification.

Implications:

• This case expands the understanding of HO presentation and potential mechanisms, even in the absence of direct intraoperative seeding at the bone harvest site.
• Further investigation into the factors contributing to HO in surgical wounds, particularly rectus sheath, is warranted.
• Awareness of this unusual presentation can aid surgeons in recognizing and potentially preventing similar complications in reconstructive surgery.